盐酸右美托咪定在局麻玻璃体切除术的临床应用

Clinical application of dexmedetomidine hydrochloride in vitrectomy under local anesthesia

目的：研究盐酸右美托咪定在局麻玻璃体切除术的临床应用。方法：80例择期玻璃体切除术患者,ASAⅠ~Ⅱ级,随机分为右美托咪定组（D组,n=40）和对照组（C组,n=40）,右美托咪定组患者术前先经输液泵缓慢静脉注射右美托咪定0.5μg/kg负荷剂量,10 min泵完,然后以0.5μg.kg-1.h-1速率持续泵注至术毕。对照组持续泵注相同容量的生理盐水至术毕。两组患者均在局麻下完成玻璃体切除术。记录两组患者麻醉前（T0）、手术开始（T1）、手术30 min（T2）及术毕（T3）平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SPO2）、呼吸频率（RR）、镇痛镇静评分及不良反应。结果：两组患者在T1、T2、T3时点,D组HR、MAP、RR、SPO2、疼痛VAS评分均低于C组,而镇静Ramsay评分高于C组,差异有统计学意义（P〈0.01）,各个时点D组与C组SPO2相比无统计学差异（P〉0.05）。与C组相比,D组患者麻醉手术中恶心、呕吐、呼吸抑制等不良反应发生率未见统计学差异（P〉0.05）。结论：静脉应用小剂量右美托咪定可以减轻局麻玻璃体切除术患者术中疼痛,有效减少血流动力学波动,并提供一定的镇静效果,且对呼吸不产生抑制。

Objective： To investigate the clinical application of dexmedetomidine hydrochloride in patients undergoing vitrectomy under local anesthesia. Methods：A total of 80 cases of vitrectomy, ASA Ⅰ- Ⅱ were randomly divided into test group and control group. Load dose of dexmedetomidine（0.5 μg/kg） was infused slowly in 10 mins in test group by infusion pump before operation, then continuously pumped at the rate of 0.5 μg.kg-1.h-1until the end of the operation.The same volume of saline was infused in the same way in control group. The vitrectomy surgery was under local anesthesia. The mean arterial pressure（MAP）, heart rate（HR）, saturation of Pulse oxygen（SPO2）, respiratory rate（RR）, score of sedation or analgesia and adverse reactions of patients were recorded before anesthesia（T0）, at the beginning of operation（T1）,30 min after operation（T2）, and at the end of the operation（T3）. Results： The value of HR, MAP, RR and VAS in test group were significantly lower than those in control group at the time point of T1, T2, T3（P 〈0.01）, but the sedation score of Ramsay in test group was significantly higher than that in control group at the point of T1, T2, T3（P 〈0.01）. However there was no significant differece in SPO2 at every time point between two groups（P 〉0.05）. Compared with control group, there was no significant differece in the incidence of nausea, vomiting and respiratory inhibition in test group（P 〉0.05）.Conclusion： Intravenous administration of low dose of dexmedetomidine could relieve pain in patients undergoing vitrectomy under local anesthesia, reduce fluctuation of hemodynamics, and provide some sedative effects with no respiratory inhibition.